thoughts from the night shift

Welcome to the night shift. The best and worst of life as seen through the eyes of an ER Trauma nurse.

Saturday, October 31, 2009

Its the Great Pumpkin

Do you ever wonder about the Perfect Storm? A series of events that individually wouldn't be a big deal, but when combined are a big fuckin nightmare? Well thats what I'm seeing tonight. Its Saturday (sucks), its Halloween (sucks ASS), its fall-back day(FUCKER), the computer system is going down at midnight (MOTHERFUCKER) and oh yeah..... I'm in CHARGE tonight! ARRRUUUGGHHH!!!

Fuck that shit.

Pardon my language. Given the pending gloom and doom I think it is warranted. I have a feeling the the Green ER is not going to be the most sincere pumpkin patch this evening. Maybe the Great Pumpkin will rise outta another patch and bring all the drunks and psychos to the most deserving ED (and leave us and our Influenza-Like-Illness aka ILI alone!).

Wednesday, October 28, 2009

Fuckin Flu

So nada good going on in the ER these days. The flu is rampant (of course) and I think there must be a psychological component because these have to be the stupidest patients I have seen in a while. Kids with temps of 103 and the parents, when asked about tylenol/motrin etc respond "that’s why I brought him here." At 2am with the rest of your damn family. I actually had a mother bring a kid in for a runny nose that didn't think they should have to wait in the waiting room because she didn't want her kid to get sick. I explained that this IS a hospital, not a mall and that if she wanted a mask for her child then I could give her one. She refused. WTF?!?!? People are so fucking stupid.

Before I leave my flu rant in the dust let me also vent my frustrations about the management. They KNEW this was going to be a fucking nightmare. I think we all knew that this flu season was going to be bad. Did they prepare ahead of time? Negative. They have a "Flu Tent" that has been up in years past. Was it up when this shit started? Nope. They have decided to move the different areas around to make a dedicated "Flu ER." Did they know how they were gonna staff it??? Nope. I got a call yesterday. It was a recording from the ER saying that "We are excited to announce our new Flu ER! We are giving you the opportunity to work overtime from 9a-9p. Please call to schedule your shift!" Ummmm so what happens when NONE of us want to work there? I'm entertaining it just for extra Christmas money. Will check the schedule tonight and see just how fucked up this thing looks.

My paramedic class has gotten a touch of drama on as well. These Type A bitches are really pushing my Type B buttons. We are a new hybrid of the paramedic class. Things that are generalizations towards other classes don't fit ours and there is some flexibility that has to be accepted. That said..... we spend greater that 20 minutes each class hashing out the drama for the type A's in the group. This is all well and good when I have slept the night before and am slowly drinking my coffee and waking up. However, when I worked in flu hell the night before, haven't gotten my coffee on and generally not in a great mood... you'd better watch out. It was all I could do to keep my mouth shut. Even better?!?!? When the lecture started it was trauma and neuro. The teacher kept going to me with the classes because of my background. I should have just taken a nap!
Yesterday I got a call from the queen of the high maintenance bitches in my class. She had her first clinical in my ER. I was expecting she was gonna fly off the deep end. We are a bit off the chain these days and I didn't think a super control freak would feel comfortable there. I was wrong. She was blown away by our little shithole. She actually said that I was very fortunate to work in such an amazing place and that the experience as very humbling. Wow.... very interesting.

Finally, on the advice and support of friends (including you guys!) I have decided to just say FUCK IT and run away for a couple of days. Super nice, all inclusive resort in the Caribbean here I come! (In less than 2 weeks!!!!) Every time someone starts bitching about the long waits, the flu or getting super Type-A, I just hum some Buffett and Marley and go somewhere else.

Tuesday, October 20, 2009

Please sir, I want some more....

For the second time this year I have had the privilege of a phone call from work saying "hey... your (first was the husband, this time grandmother) is in the trauma room." She is 76, still driving and managed to hit another car head on in the rain. The other folks are ok; she spent the weekend in Trauma ICU and is now terrorizing the nurses on the floor. The upside (again) is that I know all of the trauma docs very well and they have kept me well updated.

I'm a firm believer that god doesn't put anything on your plate that you can't handle, but damn this has been a full plate this year.

I picked up a day shift yesterday. Let me just say... the HELL with that! Even with the staff, who were mostly evening shift doing overtime, it sucked ass! Too many people in too small a space. Too much drama and not enough common sense. People keep telling me that I will give up on night shift someday.... I highly doubt it. I truly don't think that I need 20 people in the room to work a post-cardiac arrest. Give me 2 strong nurses, a medic, a really good resident and an attending and I think we can take on the damn world. I couldn't even get to the monitor yesterday for all the people!

Let me also say that the flu is out in full force around here. So much so that all of the triage nurses are now to classify anyone coming in with flu symptoms as "ILI" in the chief complaint box. ILI= influenza like illness. This way our total visits can be tracked. Unfortunately, unless you are sick as dogshit we aren't going to do much for you.

Friday, October 16, 2009

Just freakin' gross

There are some statements that truly need to be repeated. I once told a special forces medic that the texture on our temperature sensing foley was "ribbed for his pleasure." (I have yet to live that one down)

Occasionally, our male nurses have to chaperone a pelvic exam. They don't like to do it and bitch like crazy afterwards. Yesterday one of the guys had to go in on a less than appetizing exam. His response... "that looked like a bulldog eating mayonnaise."

The mental picture still makes me cringe.

Crazy as shit psych/seizure patient went ape-bonkers last night after enough ativan to kill a horse. I counted 4 cops, 2 docs, 2 special forces, 2 nurses (me and lurch) and a medic. How I always end up on the bottom of the pile on these, I will never know. We were convinced that he shit himself until we realized that the smell was dudeman's breath. He went upstairs after a B52 of ativan, haldol and benadryl. I tried to ignore the distinct crunch of his wrist when I put the restraints on!

Thursday, October 15, 2009

Holding down the fort

Some days it’s nice to walk in, not be in charge and not be in triage. Just holding down a zone or (gasp!) the trauma room is somewhat relaxing. As I have said many times before, we have some staff that are really scary. Maybe even to the point of negligent. Honestly though I doubt this is a purposeful act... and maybe blissfully ignorant is a better word. I think they would be exceptional school nurses, clinic nurses maybe even basic (and I mean BASIC) med-surg teachers, but they have absolutely no place in the world of acute emergency medicine!

I took the trauma room over from one such nurse the other day. The room was absolutely trashed. All kinds of shit missing to include Ambu bags, stylets in the airway carts and suction equipment. I asked the charge nurse what the hell happened.... she said the nurse's name rolled her eyes and then told me there was one trauma in there ALL day..... thats it! Ugh.... so this bitch can't even handle an easy, not-so-sick trauma. What is she going to do when they open a chest? Work a big burn? Or god forbid a police/fire/rescue person where tensions are ALWAYS high? One of the docs listened to me rant and suggested that I write her up. Unfortunately, until I actually see her fuck up or hurt someone I have no grounds to say that she is a moron.....even though it is a well known fact!

After cleaning the room from top to bottom, pulling all of the extra crap out of the carts and reorganizing, I was finally ready to rock and roll. We took a transfer from a Level 2 trauma center. 65yo F that had central cord syndrome from an MVC. She arrived fully dressed from the waist up.... although they had taken the time to cut her pants, unsnapped her little girdle-leotard thing and placed a foley. She had not been taken off the backboard or hard collar at the other hospital. Her accident was at 1300.... she arrived to us at 2045! Almost 8 hours on the fucking backboard! That is criminal! We got her off the board, into an aspen collar and into a warm gown. Ironically, once she was off the board all of her peripheral weakness went away and she was just fine. CT's were normal but she stayed for observation (and possible workup for decubs and rhabdo!).

As it gets cooler we are getting more of the "street variety" type patient. Is not so cold that they are complaining of chest pain or suicidal ideations (that warrants an actual workup) they are just coming in drunk. The new PC term for the homeless???

Urban Camper

I love it!

PS: had an exposure to a known swine flu patient for the second time in 2 months. That nasal spray better fucking work!

Friday, October 09, 2009

How Many?

How many grown police officers does it take to control a crackhead?

I really wish I had take pictures to illustrate. I was sitting in triage after one HELL of a first 8 hours trying to catch up on my reading for paramedic class, when an officer we all know well comes through needing some help. One of his guys has the wagon and is bringing a "crazy crackhead" for us to check out. I grab a stretcher and some friends and we head out to the ER driveway. Our buddy the officer is out there with gloves, another officer pulls up, and another and another. Before the wagon even arrived I counted about 12 officers gloved up and ready to roll. We even had staff members from other units who had come outside to smoke and stayed for the show.

As the wagon (finally) pulled up I asked "So is this chick a sasquatch or something?" Apparently not. The doors opened and... nothing. Absolute silence. Someone in the back even asked "is she still in there?" Yup... huddled in a corner, a 21 year old, 120lb girl who had been so cracked out of her mind that she gave a 6'0, 200lb officer a run for his money. They hauled her out of the wagon by her arms and legs, plopped her face down on the stretcher and she rode, Superman-style, into the ER. She didn't start fighting until she got into the room and the Dr came to evaluate her.

Wednesday, October 07, 2009

Stress???

In my last flight interview I was asked... "What stresses you out?" I answered without pause... "Being in charge." I don't enjoy it even though I am told that I do a decent job. Being charge at a Level 1 Trauma Center... esp. when diversion is considered a sign of weakness is like a combo of air traffic controller, ultimate fighter ref and psychotherapist all rolled into one. Most nights I am able to keep it together, control the flow and check most attitudes at the door. Last night was not such a night. Well, I take that back... the latter half was pretty freakin good.... it was the first that sucked my will to live.

For example.....

There are some smells that stick with you. Coffee, cinnamon at Christmas, burned hair/skin, the coppery smell of blood AND.... TAAADAA... the funk of a scrotal abscess that has been festering greater than 2 weeks in the pants of an unwashed crackhead who cannot for the life of him keep the hands OFF the twig and berries. GROSS!!! There was some discussion whether his breath or balls smelled worse. I think urology found out quickly that they were getting the short end of this deal.

Also.... the moon MUST be full. I can't tell from looking because it has been too busy for me to even go outside at night to see. The psych patients have literally come in droves and have overflowed the normal "psych zone" and are now in the hall, down the hall and around a corner. Today as soon as I got report one such patient decided to enlighten us all with the info that 1) he was a teacher and when he gave blood Obama was elected president 2) we can't keep him here and 3) we had better give him his fucking pain medicine or he was gonna whoop our asses. I figured we could stand about a foot out of his reach and do whatever we wanted.... he wasn't leaving. Paralysis is a bitch like that, huh?

I think the closest I came to actually fucking someone up was a 45 year old dialysis patient who was late for her dialysis, had chronic neck pain and wanted her Percocet refill, dammit! She raised holy hell that the MD was only going to give her Tylenol, she didn't want her blood dawn and she NEEDED 3 mayos for her turkey sammich. When she demanded that the Medicaid cab ride take her somewhere other than her home address she was escorted out by her resident and some of the University's finest.

We also came up with a brilliant idea. Had to send an extra fluffy resp patient home (to cont smoking her 2 packs a day!) via ambulance for the O2. A complete waste of time in my opinion. Our solution... have her put her head out the window on the way. 55 mph should afford at least 5 of PEEP! Hell, have the driver speed up and slow down and she is on Bi-level!!!!

Finally, OMAA.... we got medieval on the only real sicko of the night.... Hep C, Liver CA, varices, SOB and vomiting over 2L blood PTA. We were dressed, draped and ready to rock and roll. He had 2 lines, 4 liters of NS, EKG, CXR and labs in the 20 minutes from arrival until shift change. (My nurse refused to place an NG... and I had her back 100%.... the attending could do that... we don't drop NG tubes in someone with bleed fuckin varices! Give me a break!) I had to explain to the stupidest charge nurse in America why this was a RED patient. I would question if she was truly that fucking stupid, but yes, she is.

So yes... please let the chief flight nurse AND the educator and whoever else that wants to know. Being in charge fucking stresses me out!!!

Friday, October 02, 2009

Silver Lining

New adventure??? Who knows? Tonight I ran into an old acquaintance who presented a new fork in the road. She is an organ procurement coordinator. She evaluates donor candidates, (occasionally) consents families and then manages the care of the patient from consent to OR. I have worked with these patients before. Donor patients are the sickest and most challenging that I have ever taken care of. With my background I could probably be pretty successful.
What about flying? I still miss it every day. I still dream about it at night, and can't help but smile when I hear an aircraft overhead. Not ready to give up on that dream yet, but the ER is still sucking my will. I don't know that I would be happy in the ICU. It took all I had just to suffer through neuro as long as I did. Will a cardiac surgery or pedes ICU be any better? Hell if I know. ARRUUUGHGGGH.....